COVID 19: A Family Physician’s Perspective

By: Dr. Chuck Williams

As spring began last week and brought a welcome end to a cold, wet winter the news of improving COVID19 statistics gave us even more reason for optimism and hope.  The long, difficult pandemic of the last year, which led to loss of life, illness, stretched health care resources, economic hardship, and an educational crisis, finally seems to be abating.

Do we really have reason to be hopeful that all will continue moving in the right direction?  Or will we see another spike in numbers this spring and summer?  I’ll address some of the common questions we discuss with patients in our office every day and hope that it provides some clarity as to where it looks like our county, state and country appear to be headed.

Is the number of COVID19 cases still declining?

The highest peak of the pandemic numbers for our state occurred in mid January.  This was presumably due to indoor congregating in the winter months combined with holiday travel, which carried the virus from gathering to gathering.  Mercifully we began to see a decline in total cases toward the latter part of January and into February.  Though hospitals were over capacity and stretched thin through much of the winter, public health experts agree things could have been worse in many communities.

An examination of the numbers demonstrates that since the beginning of March our state’s daily case count has plateaued at around 2000 cases per day, which shows there is still work to be done in suppressing the virus to tolerable levels.  There are some states where the case count is already rising again after a plateau.

A more useful number to consider is the positive percentage of all tests performed in a given time frame. This eliminates the numbers being skewed by the variance in numbers of tests being performed day-to-day or week-to-week. The World Health Organization considers 5% of tests turning up positive for COVID19 to be a reasonable number to aim for community control of the virus.  At the height of the pandemic Johnston County reported a double-digit positive percentage but at latest report we are hovering around 5%.

Finally, our hospital census situation is much improved.  Both UNC campuses in Clayton and Smithfield have been caring for COVID19 patients throughout the pandemic and the staffs there are to be commended for their tireless work.  While we should continue to pray for and support those families who still have loved ones seriously ill in the hospital with COVID19, our ability to care for these patients feels much more manageable now that it did in January.

Will the COVID19 virus ever disappear?

Most experts say no. The 1918 worldwide influenza pandemic may offer a model of what could happen with COVID19.  Up to a third of the world’s population was ultimately infected with that strain of influenza but it eventually mutated to a less virulent form that still circulates today. Public health officials are hopeful that COVID19 follows the same path – while it may stay with us for years to come it will become a nuisance causing milder disease than the serious health threat it has posed the past year.

How are things going with the vaccine?

On the whole, amazingly well.  Over 130 million doses have now been given in the United States.  Around 20% of Johnston County residents have now received at least one dose of the vaccine.

If one had polled all the scientists who work in virology, infectious disease and public health at the beginning of the pandemic and asked if we would have an effective, commercially available vaccine by the end of 2020 there would have been few, if any, who responded affirmatively.

The design and production of the vaccine is nothing short of miraculous and is a real tribute to the hard working men and women who spent countless hours designing, testing, and manufacturing it.

The distribution of the vaccine proved to be challenging at first with the limited supply that was available.  The logistics of trying to immunize 200 million American adults is daunting to say the least.  Our county’s approach is one that has been replicated across the country – use every means necessary to get the vaccine out to as many people as possible as efficiently as possible.  Johnston County has used doctor’s offices, pharmacies, churches, and school parking lots to administer doses. 

The weekly large outdoor clinics – often immunizing close to two thousand people per day – are a wonderful example of our county’s emergency management system, law enforcement, health department staff, and volunteers working together for the common good. All our citizens should applaud their dedication and commitment to this difficult task.

Our state and county also remain committed to getting the vaccine out equitably to all citizens and have made great strides in seeking out communities with transportation issues, chronic health concerns and compromised access to our health system.

Is the vaccine safe and effective?

Yes. All vaccines carry risks of side effects but on the whole the COVID vaccine does not seem to differ much from those seen with other vaccines.  The most common ones we’ve seen with our patients are a sore arm, body aches, fatigue and headache. Many of our patients have reported no side effects at all.

The effectiveness of the vaccines is also quite impressive.  While a typical flu vaccine might provide 50-60% effectiveness in a given season, the Moderna and Pfizer COVID19 vaccines provided an incredible 95% efficacy in clinical trials.  A recent “real world” study verified the number at around 90%.  All three licensed U.S. vaccines – including the Johnson and Johnson product – provide 100% effectiveness in preventing severe illness and death.

Who should get the vaccine?

Essentially everyone sixteen and older should be vaccinated. Starting April 7 all North Carolinians, regardless of health status, will be eligible. To find a location giving vaccines near you visit www.myspot.nc.gov.

Will children be eligible for the vaccine?

Right now the Pfizer vaccine is indicated for ages 16 and older. Both Moderna and Pfizer have enrolled patients in trials aged twelve and older so expect to see some recommendations on vaccinating older children this summer.  Moderna also began enrolling children six months and younger in a trial this month.  We don’t expect any recommendations for children under the age of twelve until 2022.

Will we have to keep getting the COVID vaccine every year?

Possibly.  Currently, immunity levels still look good in those who received the vaccine early on.  The COVID vaccine may be recommended annually like the influenza vaccine moving forward. Time and ongoing studies will provide us those answers.

What about variants of the virus?

While a couple of dominant variant strains of the virus are emerging in some communities in the United States, the vaccines thus far seem to be offering at least partial protection. One reason for the urgency of vaccinating as many people as we can is to stop the rise of these variants. As we inch closer to “herd immunity” – getting around 75-80% of the population vaccinated – the COVID virus will eventually run out of hosts. Viruses can’t continue without human hosts so by reducing the number of people susceptible to COVID the variants will become less problematic.

When can we stop wearing masks everywhere?

This question comes up frequently.  The short answer is we can stop wearing masks when COVID is no longer a major public health threat. How do we measure that? Some of the metrics discussed earlier: case count, hospital census, positive test percentages, and how many individuals have been vaccinated.  There will likely be some settings – medical offices and hospitals for example – that continue requiring masks for some time to come. 

In summary, there is reason for optimism in the fight against COVID but we can’t let our guard down yet.  The recent rise in cases in some parts of the country demonstrates the virus is still prevalent and easily transmissible. We should continue wearing masks when appropriate, wash our hands frequently, and social distance when possible.  You should seek out a vaccine when it’s your turn. 

The long marathon run battling this virus the past year is entering a final phase and the finish line appears to finally be in sight.  To complete the race successfully we must continue to pull together, love our neighbors by following public health recommendations, keep up our efforts at community mitigation and get everyone vaccinated as quickly as we can.

Chuck Williams, MD is a family physician with Horizon Family Medicine of Clayton.  Dr. Williams is the co-founder of Project Access, a medical non-profit dedicated to providing healthcare for the uninsured of Johnston County.  He also serves as medical director for Ichoose Pregnancy Support Services.